Object Skull base chondrosarcomas are slow-growing, locally invasive tumors that arise from the petroclival synchondrosis. These characteristics allow them to erode the clivus and petrous bone and slowly compress the contents of the posterior fossa progressively until the patient becomes symptomatic, typically from cranial neuropathies. Given the site of their genesis, surrounded by the petrous apex and the clival recess, these tumors can project to the middle fossa, cervical area, and posteriorly, toward the cerebellopontine angle (CPA). Expanded endoscopic endonasal approaches are versatile techniques that grant access to the petroclival synchondrosis, the core of these lesions. The ability to access multiple compartments, remove infiltrated bone, and achieve tumor resection without the need for neural retraction makes these techniques particularly appealing in the management of these complex lesions. Methods Analysis of the authors’ database yielded 19 cases of skull base chondrosarcomas; among these were 5 cases with predominant CPA involvement. The electronic medical records of the 5 patients were retrospectively reviewed for age, sex, presentation, pre- and postoperative imaging, surgical technique, pathology, and follow-up. These cases were used to illustrate the surgical nuances involved in the endonasal resection of CPA chondrosarcomas. Results The male/female ratio was 1:4, and the patients’ mean age was 55.2 ±11.2 years. All cases involved petrous bone and apex, with variable extensions to the posterior fossa and parapharyngeal space. The main clinical scenario was cranial nerve (CN) palsy, evidenced by diplopia (20%), ptosis (20%), CN VI palsy (20%), dysphagia (40%), impaired phonation (40%), hearing loss (20%), tinnitus (20%), and vertigo/dizziness (40%). Gross-total resection of the CPA component of the tumor was achieved in 4 cases (80%); near-total resection of the CPA component was performed in 1 case (20%). Two patients (40%) harbored high-grade chondrosarcomas. No patient experienced worsening neurological symptoms postoperatively. In 2 cases (40%), the symptoms were completely normalized after surgery. Conclusions Expanded endoscopic endonasal approaches appear to be safe and effective in the resection of select skull base chondrosarcomas; those with predominant CPA involvement seem particularly amenable to resection through this technique. Further studies with larger cohorts are necessary to test these preliminary impressions and to compare their effectiveness with the results obtained with open approaches.
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机译：对象颅底软骨肉瘤是缓慢生长的，局部侵入性肿瘤，来自Petroclival Synchondrosis。这些特性允许它们侵蚀康西平群和岩骨并逐渐缓慢地压缩后窝的内容，直到患者变得症状，通常来自颅神经病。鉴于其创世纪的遗址包围，被岩顶和夹具凹陷，这些肿瘤可以突出到中窝，宫颈区域和后部，朝向小脑角度（CPA）。扩大的内窥镜内窥镜前进方法是多功能技术，可授予对Petroclival同步趋势的访问，这些病变的核心。进入多个隔室的能力，去除渗透骨，并在不需要神经缩回的情况下实现肿瘤切除使得这些技术在这些复杂病变的管理中特别吸引。方法分析作者的数据库产生了19例头骨基础软骨肉瘤;其中5例具有主要的CPA参与。 5名患者的电子病历回顾性地审查年龄，性别，介绍，预测和术后成像，手术技术，病理和随访。这些病例用于说明CPA软骨肉瘤的内切除切除术中涉及的手术细微差别。结果雄性/女性比例为1：4，患者的平均年龄为55.2±11.2岁。所有病例涉及岩石骨和顶点，具有可变的延伸到后窝和滑动术空间。主要的临床情景是颅神经（CN）麻痹，由复视（20％），脑病（20％），CN VI麻痹（20％），吞咽（40％），障碍（40％），听力损失（ 20％），耳鸣（20％）和眩晕/头晕（40％）。在4例（80％）中取得了肿瘤CPA组分的总切除术;在1例（20％）中进行CPA组分的近总切除术。两名患者（40％）毛白患者高档软骨肉瘤。没有患者术后患有神经系统症状恶化。在2例（40％）中，手术后症状完全标准化。结论扩增内镜型内外方法似乎在Select Searull Base Chondrosarcomas的切除方面是安全有效的;具有主要CPA参与的人似乎特别适合通过这种技术切除。需要进行更大的群组的进一步研究来测试这些初步印象，并比较它们的有效性与开放方法获得的结果。
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